Submitted by: Email:
Date of Request: Start of Term - Month: Year: University of Louisville Course Name: Course Number: Instructor: Est. No. Copies:
Use separate blocks below for each page series even if there are multiple series from a single source.
Book/Journal Title: Chapter/Article Name: Publisher: Yr Pub'd: Vol/Ed: ISB(S)N: Author: Number of Pages: From To
If you have any more entries please submit another Permission Request form.
University Libraries | University of Louisville | Louisville, KY 40292 | 502-852-6747 Site Index | Contact Us | Staff Intranet